| NPI | 1932254331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 0099-01380) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 9001380) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-03-31 |